Jensen Morten Daniel, West Joe, Crooks Colin, Morling Joanne R, Kraglund Frederik, Card Tim, Askgaard Gro, Jepsen Peter
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Am J Gastroenterol. 2025 Mar 1;120(3):593-602. doi: 10.14309/ajg.0000000000003077. Epub 2024 Sep 9.
Patients with alcohol-related cirrhosis (ALD cirrhosis) have an increased risk of primary liver cancer (hepatocellular carcinoma [HCC] or intrahepatic cholangiocarcinoma [iCCA]). England recommends surveillance for HCC in these patients, while Denmark does not.
We performed an observational cohort study using the English Clinical Practice Research Datalink and the nationwide Danish healthcare registries to identify 17,110 English (2000-2016) and 22,122 Danish (1994-2022) patients with diagnosis codes of ALD cirrhosis. We computed and compared incidence rates and cumulative incidence of primary liver cancer, annual ultrasound scan rates, and mortality following diagnosis of primary liver cancer.
The overall risk of primary liver cancer was similar in England and Denmark: 5-year risk was 2.24% (95% confidence interval 2.00-2.49) in England (iCCA 0.07%, HCC 2.16%) and 2.36% (2.15-2.57) in Denmark (iCCA 0.05%, HCC 2.30%). The annual rate of ultrasound scans per person was 0.65 (0.63-0.67) in England and 0.44 (0.42-0.46) in Denmark. The 1-year mortality after a diagnosis of primary liver cancer was 59.2% (54.4-64.0) in England and 60.9% (57.4-64.4) in Denmark. The 3-year risks of HCC in those on vs off surveillance in England were 2.3% (1.0-4.6) vs 1.5% (1.0-2.2).
The risk of primary liver cancer was the same in English and Danish patients with ALD cirrhosis, and HCCs constituted 97% of primary liver cancers. Mortality with primary liver cancer was equally high in both countries. Notably, in England, where guidance recommends biannual HCC surveillance with ultrasound, patients with ALD cirrhosis were undergoing fewer than 1 ultrasound scan per year.
酒精性肝硬化（ALD肝硬化）患者患原发性肝癌（肝细胞癌[HCC]或肝内胆管癌[iCCA]）的风险增加。英国建议对这些患者进行HCC监测，而丹麦则不建议。
我们利用英国临床实践研究数据链和丹麦全国医疗保健登记系统进行了一项观察性队列研究，以识别17110名英国患者（2000 - 2016年）和22122名丹麦患者（1994 - 2022年），他们的诊断代码为ALD肝硬化。我们计算并比较了原发性肝癌的发病率和累积发病率、年度超声扫描率以及原发性肝癌诊断后的死亡率。
英国和丹麦原发性肝癌的总体风险相似：英国5年风险为2.24%（95%置信区间2.00 - 2.49）（iCCA为0.07%，HCC为2.16%），丹麦为2.36%（2.15 - 2.57）（iCCA为0.05%，HCC为2.30%）。英国每人每年的超声扫描率为0.65（0.63 - 0.67），丹麦为0.44（0.42 - 0.46）。英国原发性肝癌诊断后1年死亡率为59.2%（54.4 - 64.0），丹麦为60.9%（57.4 - 64.4）。在英国，接受监测与未接受监测的患者中HCC的3年风险分别为2.3%（1.0 - 4.6）和1.5%（1.0 - 2.2）。
英国和丹麦ALD肝硬化患者原发性肝癌的风险相同，且HCC占原发性肝癌的97%。两国原发性肝癌的死亡率同样很高。值得注意的是，在英国，指南建议每半年用超声进行HCC监测，但ALD肝硬化患者每年接受的超声扫描少于1次。
